• Couples Center of the Pioneer Valley

    Please answer the following questions so we can provide you with an available appointment based on your insurance, availability, and preferences. You will receive an email with information on what to expect from our center upon the form submission.
  • Please make sure to check spam folder for emails from intake@pioneervalleycouplestherapy.com

  • Basic Information

    If you decide to move forward with therapy, we'll need the following information to create an account for you inside our therapy portal.
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  • Insurance

    If using insurance, we ask you to provide your insurance information on this form so that we can run your benefits and notify you how much your insurance is going to cover and if there is any deductible that needs to be met.
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  • Specialized Services

    Please note that our specialized services below are not covered by insurance.
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